RCPsych Members’ Survey: Views on the Mental Health Act Review
Aims and methodRCPsych President Wendy Burn launched a survey in August 2017 to gauge opinion of members in anticipation of the Mental Health Act Review. It was intended that the results of the survey would help inform the College’s engagement with the Review.
RCPsych College Officers and College staff collaborated to write the questions. The survey focused on the main areas of concern that had been raised by the Prime Minister, and those that had already been tackled by the Mental Health Alliance Survey of 2017. As well as multiple choice ques-tions, there was also an opportunity for respondents to enter free text on areas they thought were important.
The survey was sent out by email to all RCPsych members in England and Wales with further opportunities and reminders to respond between 15 August and 8 September 2017.
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RCPsych Members’ Survey: Views on the Mental Health Act Review
Results
Response rate
The survey received a total of 1,951 responses which equates to 15% of all RCPsych members across England and Wales.
Geographic demographics
1,835 of the survey respondents (94%) indicated their Division. Response rates varied from 10% in Trent to 21% in Northern & Yorkshire. You can view a summary of the responses from each Division listed below by clicking on its name in the key.
The following map shows the individualresponse rate from each Division as calculated when compared to the total number of registered members in that Division.
Respondents by Division
3
Eastern
London
Northern & Yorkshire
North West
South East
South West
Trent
Wales
West Midlands190
168145
203
235
424
9681
19%
10%
21%
13%
14%15%
12%
14%
13%
293
RCPsych Members’ Survey: Views on the Mental Health Act Review
Psychiatric specialty demographics
All psychiatric specialties were represented in the survey and were broadly in line with the psychi-atric specialty demographic. The chart provides a list of psychiatric specialties and the percentage of each specialty that made up the respondents to this survey. Those who didn’t respond to this question have been omitted from this graph. By clicking on the name of the faculty, you will be taken to a link to a report where you can review a summary of the response from that specialty:
Number of respondentsNumber of respondents
300 400
4
Addictions
Children and younger people
Eating disorders
Forensic
General adult
Intellectual disability
Liaison
Medical psychotherapy
Neuropsychiatry
Old age
Perinatal
Rehabilitation and social
Other (incl. non-practising academics)
26 (1%)
189 (10%)
10 (0.5%)
169 (9%)
718 (39%)
105 (6%)
89 (5%)
30 (2%)
19 (1%)
240 (13%)
18 (1%)
48 (3%)
174 (9.5%)
0 100 200 300 400 500 600 700 800Other including non-practising academics
Rehabilitation and Social
Perinatal
Old Age
Neuropsychiatry
Medical Psychotherapy
Liaison
Intellectual Disability
General Adult
Forensic
Eating Disorders
Child and Adolescent
Addictions
0 100 200 700 800500 600
RCPsych Members’ Survey: Views on the Mental Health Act Review
Part 1: Principles of the Mental Health Act
We asked members their thoughts on some of the key principles of the Mental Health Act. This was primarily to find out whether psychiatrists believed that a Mental Health Act that admitted some people to hospital against their wishes is necessary.
A majority of respondents agreed that compulsory treatment in hospital was sometimes necessary for their own or others’ safety.
Question 1: Non-consensual medical treatment
Question 2: Involuntary admission of those with capacity who pose a risk to themselves
0
200
400
600
800
1000
1200
278 (14.3%)
1173 (60.3%)
493 (25.4%)
Nu
mb
er
of
resp
on
de
nts
0
200
400
600
800
1000
1200
199 (10.3%)
555 (28.7%)
1183 (61%)
Nu
mb
er
of
resp
on
de
nts
Yes No Not sure
Yes No Not sure
Do you think the law on the non-consensual medical treatment of mental illness should be the same as for physical illness?
Should it be possible to admit people to hospital against their wishes if they have capacity to make their own decisions, but pose a risk to
themselves?
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RCPsych Members’ Survey: Views on the Mental Health Act Review
Question 3: Involuntary admission of those with capacity who pose a risk to others
Question 4: Treating people with medication against their wishes even if they have the capacity to make decisions about their mental health treatment
Yes No Not sure
0
300
600
900
1200
1500
132 (6.8%)
Yes
388 (20%)
1417 (73.2%)
No Not sure
Nu
mb
er
of
resp
on
de
nts
0
200
400
600
800
1000
1200
Yes No Not sure
1049 (54.2%)
602 (31.1%)
285 (14.7%)
Nu
mb
er
of
resp
on
de
nts
Should it be possible to admit people to hospital against their wishes if they have capacity to make their own decisions, but pose a risk to
others?
Should it be possible, in some circumstances, to treat people with medication against their wishes, even if they have the capacity to
make decisions about their mental health treatment?
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RCPsych Members’ Survey: Views on the Mental Health Act Review
Part 2: Treating people in the community
This section was aimed at establishing the members’ view on Community Treatment Orders, which are a large part of the remit of the Review. We hoped to establish whether members ap-proved of CTOs in principal: i.e. some conditions applied to discharge to the community, and what they thought about CTOs in practice and whether they want to abolish them.
A clear majority of respondents agreed that some conditions applied to discharge is an important part of keeping people safe and well. However, opinion was fairly divided on whether CTOs in the current form should be abolished.
Question 5: The principle of conditions applied to discharge to the community
No Not sure
Nu
mb
er
of
resp
on
de
nts
0
500
1000
1500
2000
0
100
200
300
400
500
600
700
800
542 (28.3%)
Yes
794 (41.4%)
582 (30.3%)
No Not sure
1712 (89.2%)
98 (5.1%)
Yes
109 (5.7%)
Nu
mb
er
of
resp
on
de
nts
Are there circumstances where discharging people to the community with some conditions on their treatment can be an important part of
keeping people safe and well?
Should Community Treatment Orders, in their current format, be abolished?
Question 6: Community Treatment Orders
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RCPsych Members’ Survey: Views on the Mental Health Act Review
Part 3: Rising detentions under the Mental Health Act
Question 7: Views on the reasons for the increase in detentions
The top five factors respondents believed to be causes of the rise of detentions under the Mental Health Act were:
1. Insufficient access to community mental health services − 80.5% cited this as one of the causes of the rise
2. Insufficient access to wider public services (including housing, benefits, social care, police) − 79.2% cited this as one of the causes of the rise
3. Reduction of inpatient beds − 74.7% cited this as one of the causes of the rise4. Changes in the law that mean that patients who lack capacity can no longer be admitted
informally − 60.5% cited this as one of the causes of the rise5. Higher rates of severe mental illnesses − 18.7% cited this as one of the causes of the rise
0 300 600 900 1200 1500
Higher rates of severe mental illness
Reduction of inpatient beds
Insufficient access to community mental health services
Insufficient access to wider public services (including housing, benefits, social care and police)
Problems with the Mental Health Act itself
Problems with the Mental Health Code of Practice
Changes in the law that mean that patients who lack capacity can no longer be
admitted informally
There has been a 47% rise in the number of people detained under the Mental Health Act in the past ten years. What do you think explains this rise?
(Please tick all that apply.)
347
1383
1490
1467
218
163
1120
0 300 600 900 1200 1500
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RCPsych Members’ Survey: Views on the Mental Health Act Review
Question 8
Why is the Mental Health Act applied to more people from BME communities compared to the rest of the population in England and Wales? (Please tick all that apply.)
The top five factors that respondents believed explain why the Mental Health Act is applied to more people from BME communities compared to the rest of the population in England and Wales were:
1. More barriers to those in the BME community accessing services – 79.8% cited this as one of the causes of this disproportion
2. Discrimination within wider society – 58.1% cited this as one of the causes3. Insufficient access to wider public services (including housing, benefits social care, police –
57.6% cited this as one of the causes4. Higher rates of severe mental illnesses within some BME communities – 56.3% cited this as one
of the causes5. Insufficient access to community mental health services – 55.3% cited this as one of the causes
0 300 600 900 1200 1500
Higher rates of severe mental illnesses within some BME communities
More barriers to those in the BME community accessing services
Insufficient access to community mental health services
Problems with the Mental Health Act Code of Practice
Insufficient access to wider public services (including housing, benefits social care, police)
Reduction of inpatient beds
Discrimination within the NHS
Discrimination within other public services
Discrimination within wider society
Problems with the Mental Health Act itself
1013
995
1437
49
34
546
624
1046
485
1037
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RCPsych Members’ Survey: Views on the Mental Health Act Review
Part 4: Nearest Relative
Question 9: Patients choosing their ‘Nearest Relative’ themselves
0
200
400
600
800
1000
1200
Yes No Not sure
1179 (62.4%)
298 (15.8%)412 (21.8%)
Nu
mb
er
of
resp
on
de
nts
Should a patient be allowed to choose their ‘Nearest Relative’ under the Mental Health Act?
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